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Hindawi Publishing Corporation

Evidence-Based Complementary and Alternative Medicine


Volume 2012, Article ID 657013, 12 pages
doi:10.1155/2012/657013

Research Article
Development and Validation of a Personality
Assessment Instrument for Traditional Korean Medicine:
Sasang Personality Questionnaire
Han Chae,1 Siwoo Lee,2 Soo Hyun Park,3 Eunsu Jang,2 and Soo Jin Lee4
1 Division

of Longevity and Biofunctional Medicine, School of Korean Medicine, Pusan National University,
Busan 626-870, Republic of Korea
2 Korea Institute of Oriental Medicine, Daejeon 305-811, Republic of Korea
3 Department of Occupational Therapy, Yonsei University, Wonju 220-710, Republic of Korea
4 Department of Psychotherapy, Kyungil University, Daegu 712-701, Republic of Korea
Correspondence should be addressed to Soo Jin Lee, leesooj@gmail.com
Received 8 November 2011; Revised 15 January 2012; Accepted 17 January 2012
Academic Editor: Arndt Bussing
Copyright 2012 Han Chae et al. This is an open access article distributed under the Creative Commons Attribution License,
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Objective. Sasang typology is a traditional Korean medicine based on the biopsychosocial perspectives of Neo-Confucianism and
utilizes medical herbs and acupuncture for type-specific treatment. This study was designed to develop and validate the Sasang
Personality Questionnaire (SPQ) for future use in the assessment of personality based on Sasang typology. Design and Methods. We
selected questionnaire items using internal consistency analysis and examined construct validity with explorative factor analysis
using 245 healthy participants. Test-retest reliability as well as convergent validity were examined. Results. The 14-item SPQ showed
acceptable internal consistency (Cronbachs alpha = .817) and test-retest reliability (r = .837). Three extracted subscales, SPQbehavior, SPQ-emotionality, and SPQ-cognition, were found, explaining 55.77% of the total variance. The SPQ significantly
correlated with Temperament and Character Inventory novelty seeking (r = .462), harm avoidance (r = .390), and NEO
Personality Inventory extraversion (r = .629). The SPQ score of the So-Eum (24.43 4.93), Tae-Eum (27.33 5.88), and SoYang (30.90 5.23) types were significantly dierent from each other (P < .01). Conclusion. Current results demonstrated the
reliability and validity of the SPQ and its subscales that can be utilized as an objective instrument for conducting personalized
medicine research incorporating the biopsychosocial perspective.

1. Introduction
Personality represents a persons unique pattern of behavior,
emotionality, and way of cognition, in addition to specific
body features that interact to determine individuals adaptation to the environment [1, 2]. Disease vulnerability or susceptibility and drug response are recognized to be dierent
according to ones personality traits [36]. Since provision of
personalized medicine has been a major source of concern
across cultures, researchers have actively developed medical
typologies based on the unique biopsychological pathophysiology, diagnosis, treatment, and prevention mechanism
for its clinical application while taking into consideration

the influence of cultural and philosophical foundations [7].


The history of temperament related to health (and disease)
has a long history in the West and the East. Hippocrates
suggested the four humors: blood, yellow bile, black bile,
and phlegm as a foundation of physiology. Greek physician
Galen followed this tradition and advocated four temperaments or constitutions: sanguine, choleric, phlegmatic, and
melancholic, which have been proposed to be akin to stableextrovert, neurotic-extrovert, stable-introvert, and neuroticintrovert temperaments [79]. Furthermore, it has been a
major concern in many traditional medicines across the
world, such as Ayurveda, Tibetan medicine, and traditional
Chinese constitution medicine together with Korean Sasang

2
typology [10]. The Ayurveda from India divides humans
into Vata, Pitta, and Kapha types and stems from the
temperament of air/wind, fire/water, and water/earth, and
provides type-specific meditation, yoga/breathing, aroma
therapy, sweating, dietary instruction, and herbal therapy.
The Tibetan medicine from the Himalayan region, which is
influenced by Tibetan Buddhism and Ayurveda, emphasizes
the balance of three Nyipa sum: rLung (vayu), mKhris-pa
(pitta), and Bad-Kan (kaph). The Yellow Emperors Internal
Medicine [11] divides the human into five or 25 types with
the use of biopsychosocial characteristics based on Yin-Yang
and five-phase theory.
The traditional Korean Medicine adopted such perspectives and proposes a systematic medical typology (Table 1)
within the quaternary nature of Neo-Confucianism (sadness,
anger, gladness, and enjoyment), culminating in the four
Sasang types, each with its own characteristic temperament
and physical constitution, in addition to behavioral patterns
and tendencies, emotionality profile, logical thinking, status
of organ system, physiological and pathological features,
predisposition to a specific illness, physical characteristics,
and response to particular treatments [7, 12]. Individuals
are classified into Tae-Yang, So-Yang, Tae-Eum, and SoEum types, each with their distinctive biopsychological
temperaments and type-specific guidelines for safe and
eective medical herb and acupuncture use [7, 9, 13]. In
other words, Sasang typology embraces the philosophy that
an individuals biopsychological characteristics interact to
determine his or her response to medical treatment. The SoYang type is an active and sharp-looking person who is hottempered and interested in the outside world, and the SoEum type is an inactive, prudent, narrow-minded, resolute
and nervous [7]. The Tae-Eum type lies in between the
So-Yang and So-Eum type in regards to their psychological
features and typically has a high body fat mass or body mass
index [7, 14, 15].
Examination of corresponding Western personality traits
in Sasang typology began with the Minnesota Multiphasic
Personality Inventory in 1992 and has evolved to the
use of various objective tools such as the 16-Personality
Factor (16-PF), Myers Briggs Type Indicator (MBTI), State
Trait Anxiety Inventory (STAI), Beck Depression Inventory
(BDI), Eysenck Personality Questionnaire (EPQ), NEOPersonality Inventory (NEO-PI), and Temperament and
Character Inventory (TCI). The theoretical and descriptive
similarity of Sasang typology with the Western tradition
of personality including Hippocrates and Eysenck has been
suggested from these results [9, 14]. More specifically, the
two super factors of Eysenck, extraversion and neuroticism,
which have been mentioned as critical variables in several
personality studies including Costa and McCraes five-factor
model [16], were determined to be important personality
constructs of Sasang typology, such that the So-Yang type
scored high on the extraversion dimension and low on the
neuroticism dimension, while the So-Eum type showed the
opposite psychological profile [9]. In the previous studies,
the So-Yang type scored high on the NEO-PI extraversion
and TCI novelty seeking (NS) subscales and low on the
TCI harm avoidance (HA) subscale, and the So-Eum type

Evidence-Based Complementary and Alternative Medicine


demonstrated the opposite scores on these assessments [9,
13] (Table 1).
There have been several reports on the influence of personality traits on health [17, 18]. For example, neuroticism
or harm avoidance were found to mediate antidepressant
response [19, 20], while anxiety alters immunity related to
upper respiratory infection [21], natural killer cell activity
[22], and functional gastrointestinal disorder [23]. Such
association between disease, emotional state, and personality
highlights the interplay between biological, psychological,
and social factors in determining health status. More recent
theoretical framework in explaining personality also relies
on such a biopsychosocial model, wherein an individuals
personality is defined as an aective state (emotionality)
that is associated with expression of feelings and emotions
(behavior) that stems from the outcome of individuals
appraisal, evaluations, and decisions concerning a particular
situation and event (cognition). The measurement of aect
includes dimensions of positive and negative aect [24, 25],
while the dimension of behavior include such dimensions
as approach-action, inhibition-inaction, and flight-fight
response [25]. The dimension of cognition includes emotion
regulation strategies and broad versus narrow attentional
focus [26]. In light of such findings regarding the role of
personality in health, it will be important to objectively
and systematically examine the personality traits based on
Sasang typology. However, little progress was made due to
the lack of reliable tools satisfying theoretical and clinical
requirements. Hence, the purpose of this study was to
develop the Sasang Personality Questionnaire (SPQ) as a
novel objective tool to measure the temperaments of each
Sasang types based on previous personality studies [9]
and examine its psychological construct and validity by
comparing the tool with the TCI and NEO-PI. In this course,
we may better understand the psychological structure of
Sasang typology more systematically and make possible more
innovative and originative studies related to the relation
between temperament and health. For this purpose, we
developed the SPQ and examined it with the TCI and NEOPI scores of each Sasang type in order to determine the
reliability and validity of the SPQ. The SPQ can provide
a foundation for the study of individuality on response
to medical herbs and acupuncture from a personality
perspective, and this study would be able to contribute to
scrutinizing the biopsychological traits of Sasang typology
and make clinical application and use more ecient.

2. Methods and Materials


2.1. Participants and Procedures. Study participants were 245
students from the School of Korean Medicine at Pusan
National University and the College of Oriental Medicine
at Wonkwang University. This study was approved by the
Institutional Review Board (IRB) of the Pusan National
University School of Korean Medicine (KCRC IRB 2010-01).
All participants gave written consent for the assessments. The
mean age of the 245 participants (134 males and 111 females)
was 29.01 5.67 (range 2146).

Evidence-Based Complementary and Alternative Medicine

Table 1: Characteristics of the Sasang typology (modified from the previous studies of Chae et al. [7, 9] and Park et al. [13]).
Type (prevalence) Tae-Yang ( ) (<0.1%)

So-Yang ( ) (20%)

Tae-Eum ( ) (50%)

So-Eum ( ) (30%)

Natural
temperament

Sorrow () by
benevolence ()

Anger () by
righteousness ( )

Gladness () by courtesy
( )

Enjoyment ( ) by wisdom
()

Organ system

Developed lung and


undeveloped liver

Developed spleen and


undeveloped kidney

Developed liver and


undeveloped lung

Developed kidney and


undeveloped spleen

Developed consumption
and catabolism

Developed intake and


digestion

Developed accumulation
and anabolism

Developed waste discharge

Representative
features

Character

Active, external-oriented,
Masculine, forward moved,
Feminine, stay retracted,
talented for business, short,
and originative
conservative, tall, and big
and small
Creative, positive,
progressive, charismatic,
heroic, and rash mind

Unstable, easily get bored,


sacrificing, righteous, easily
acceptable, hot-tempered,
and anxious mind

Gentle, commercial,
endurable, humorous, look
foolish, coward, and fearful
mind

High extraversion and low


neuroticism (NEO-PI)
high novelty seeking and
low harm avoidance (TCI)
Developed nape of the neck Developed chest and small
and slender waist
hips

Neat, mild, negative,


intelligent, organized, selfish,
jealous, persistent, and
nervous mind
Low extraversion and high
neuroticism, low novelty
seeking, and high harm
avoidance

Thick waist, weak nape of


the neck

Developed hip and weak chest

Low BMI and waist-hip


ratio, low width-height
ratio of face, and smaller
neck circumference

High BMI and waist-hip


ratio. High width-height
ratio of face. Bigger neck
circumference

Same as So-Yang type, but


more smaller and slimmer

Good urination,

Good bowel movement

Good perspiration

Good digestion

bubbles in mouth, and


emesis

Constipation

No perspiration

Indigestion

Prone to diabetes and


high-insulin resistance.
More perspiration than
others

Frequent indigestion and


upper respiratory infection

Ephedrae Herba, Liriopis


Tuber, Schisandrae Fructus,
Dioscoreae Rhizoma,
Platycodi Radix, Coicis
Semen, and Puerariae
Radix

Ginseng Radix, Atractylodis


Rhizoma Alba, Glycyrrhizae
Radix, Cinnamomi Cortex,
Citri Pericarpium, Zingiberis,
and Rhizoma Crudus

Diagnosis with HT4


Treatment with
LU9(+)/LR3()

Diagnosis with HT7


Treatment with
SP3(+)/LI4()

Body shape

Sign for healthy


and unhealthy
condition

Still, internal-oriented,
self-directed, short, and small

Type-specific
useful medical
herbs

Chaenomelis Fructus,
Acanthopanacis Cortex,
and Phragmitis Rhizoma

Rehmanniae Radix, Corni


Fructus, Hoelen, Alismatis
Rhizoma, Osterici Radix,
and Angelicae Pubescentis
Radix

Type-specific
acupuncture use

Diagnosis with HT8


Treatment with
LR3(+)/LU9()

Diagnosis with HT3


Treatment with
KI3(+)/SP3()

Since 20 participants did not receive their Sasang type


classification based on the Questionnaire for Sasang Constitution Classification II (QSCCII), SPQ was examined with
the remaining 225 participants (121 males and 104 females;
mean age 28.9 5.7; range 2146). The mean age of each
Sasang type based on the QSCCII was 29.58 6.31 for the
So-Yang type (32 males and 31 females), 28.26 5.47 for the
Tae-Eum type (40 males and 20 females), and 28.79 5.52
for the So-Eum type (49 males and 53 females).
SPQ item selection using internal consistency, explorative
factor analysis using parallel analysis, convergent validity
using correlation analysis between SPQ and SPQ subscales,

TCI, and NEO-PI were performed (n = 225) test-retest


reliability of the SPQ and its subscales were analyzed (n =
45).

2.2. Measures
2.2.1. Questionnaire for Sasang Constitution Classification II
(QSCCII). The QSCCII is a Sasang typology-based inventory, which is composed of 121 forced-choice items including
typical diet habits, body shapes, temperaments, and common
health problems of each Sasang type. This questionnaire was

4
developed in 1993 and revised in 1996 and has been used
as an objective diagnostic tool in many studies examining
the biopsychological aspects of Sasang typology [9]. The
internal consistency measured with Cronbachs alpha of this
inventory is as follows: Tae-yang type is 0.57, So-Yang type is
0.57, Tae-Eum type is 0.59, and So-Eum type is 0.63 [27].
2.2.2. Temperament and Character Inventory (TCI). The
Korean version of the Temperament and Character
Inventory-Revised-Short (TCI-RS) [28] is a 140-item
self-report questionnaire that asks individuals to rate each
item on a 5-point scale (0 = not at all to 4 = very true). TCI
is a psychological assessment tool with four temperaments
(novelty seeking, harm avoidance, reward dependence,
and persistence) and three character dimensions (selfdirectness, cooperativeness, and self-transcendence) based
on Cloningers biopsychological personality model [29].
The Korean version of the questionnaire was standardized
and validated in 2007 and demonstrated validity and
reliability. Cronbachs alpha for the novelty seeking, harm
avoidance, reward dependence, persistence, self-directness,
cooperativeness, and self-transcendence scales were 0.829,
0.857, 0.814, 0.821, 0.865, 0.758 and 0.899, respectively [28].
2.2.3. NEO-Personality Inventory (NEO-PI). The NEO-PIR is a 60-item self-report inventory on a 5-point scale
(1 = not at all to 5 = very true) based on factor analysis
designed to assess a wide spectrum of individual dierences,
including the universal, stable, and consistent big five
structures of neuroticism, extraversion, openness to experience, agreeableness, and conscientiousness [30]. Cronbachs
alpha for neuroticism, extraversion, openness to experience,
agreeableness, and conscientiousness scale, was reported as
0.850, 0.766, 0.691, 0.644, and 0.720, respectively [31].
2.3. Sasang Personality Questionnaire (SPQ) Development.
The questionnaire items for the internal consistency analysis
were selected from the 42 items collected from the information database of the Sasang typology project (2006-2007) and
an online questionnaire development project (20052007)
of Korea Institute of Oriental Medicine. These questionnaire
items were based on Sasang typology theory and descriptions
of clinical characteristics of each Sasang type (Table 1). Items
that were judged to best represent the biopsychosocial aspects
while determined to be the most useful in clinical settings by
actual certified specialists based on their clinical experience
were finally selected [32].
Each item consists of two opposite words describing a
particular personality trait, and participants must respond
on a 3-point scale. This response system follows the typical
way in which Sasang-type classification is made in clinical
practice. For example, the participant can respond as delicate (= 1), average/middle (= 2), or tough (= 3) to the
question Do you have a delicate or tough personality? The
So-Eum type was expected to have a lower score while the SoYang type evidence higher score on this particular SPQ item
based on the consideration of previously reported clinical
descriptions of each Sasang type (Table 1).

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A review board composed of three traditional medical
doctors with more than 5 years of clinical experience and
one licensed medical specialist in Korean Sasang typology
then selected 15 items that were judged to have a high
association with Sasang typology and which may represent
typical features of each Sasang type.
The internal consistency of the preliminary 15-item SPQ
was examined, after which one item that revealed a low
correlation and judged to have low clinical importance
was deleted from the final version of the SPQ. That is,
the 5th questionnaire item (Q5) was deleted following
preliminary item analysis, since the Cronbachs alpha was
able to be increased up to 0.817 when deleted. Although
the 11th questionnaire item (Q11) was found to increase
questionnaires internal consistency to 0.816 if deleted, this
item was decided to be included following panel discussion
due to having clinically significant contribution to explaining
emotionality of Sasang typology. Therefore, the final 14-item
SPQ (Table 2) showed a Cronbachs alpha of 0.817.
2.4. Statistical Analysis
2.4.1. Explorative Factor Analysis, Test-Retest Reliability, and
Criterion Validity. The 14 items were subjected to explorative
factor analysis to examine the possible structure of the SPQ
using principal axis extraction and Promax rotation with
an eigenvalue over 1.0 as the criteria. We also performed
parallel analysis to get the right factor numbers using
Monte Carlo PCA for Parallel Analysis which estimates
an average distribution of eigenvalues based on a random
process that can be compared to the calculated distribution
[33, 34]. The meaning of extracted factors was analyzed by
reviewing questionnaire items while referring to the factor
loadings.
The test-retest data for the reliability examination over
a period of one month was analyzed with correlational
analysis. The reliability of SPQ and its subscales were
determined with Pearsons correlational coecients. The
criterion validity of the SPQ and its subscales were examined
by comparing the relationship with the well-established TCI
and NEO-PI. We used Spearmans correlational coecients
exceeding the minimum acceptable value of 0.3.
2.4.2. SPQ and Sasang Typology. The SPQ and its subscales
(SPQ-B, SPQ-E, and SPQ-C) were subjected to analysis
of variance (ANOVA) and profile analysis such as test
of parallelism and flatness to examine its eectiveness in
representing temperament dierences between the Sasangtype groups based on QSCC II classification. Demographic
dierences between Sasang-type groups were tested using
ANOVA for continuous variable (age) and Fishers exact tests
for categorical variables (gender).
In addition, we compared the dierences of each Sasangtype group on the TCI and NEO-PI to examine if the
participants of this study have similar characteristics as in
previous studies. ANOVA was conducted to test between
group dierences in TCI and NEO-PI scores, and Schee
was used for post hoc analysis, and the profile analysis was

Evidence-Based Complementary and Alternative Medicine

Table 2: Extracted and rotated factor-loading matrix of SPQ subscales and questionnaire items.
Factor loading

Questionnaire items

SPQ-behavior (passive/active)

SPQ-emotionality (static/dynamic)

SPQ-cognition (meticulous/easygoing)

Q3: do you consider yourself passive or proactive?


Q6: is your personality relatively introverted or extroverted?
Q7: do you consider yourself relatively lethargic or energetic?
Q2: are you relatively slow or quick?
Q13: do you tend to not express your opinions or express
well?
Q10: are you relatively patient or impatient?
Q14: do you tend to be logical or do you sometimes get
excited?
Q11: do you tend to experience little emotional change or big
emotional change?
Q12: do you consider yourself as someone who expresses
inner thoughts and feelings a little or a lot?
Q1: do you have a delicate or tough personality?
Q9: do you consider yourself feminine or masculine?
Q15: do you tend to act meticulously or hastily?
Q8: in general, do you make decisions with diculty or with
ease?
Q4: do you tend to be relatively indirect or direct when
expressing yourself?

1
0.761
0.721
0.693
0.691

2
0.234
0.179
0.059

3
0.177
0.289
0.246
0.013

0.582

0.36

0.257

0.028

0.754

0.154

0.082

0.722

0.049

0.042

0.714

0.269

0.37

0.559

0.094

0.172
0.26
0.122

0.007
0.004

0.488

0.813
0.721
0.579

0.346

0.141

0.524

0.36

0.327

0.51

0.076

Table 3: Extraction of SPQ subfactors with explorative factor analysis using Promax rotation.
Factor

1
2
3

Extraction sumsof squared loadings


Cumulative
percent of
Eigenvalue
variance
percent
4.410
31.501
31.501
2.086
14.904
46.405
1.311
9.362
55.767

Table 4: Test-retest reliability for the SPQ and its subscales.

SPQ
SPQ-Behavior
SPQ-Emotionality
SPQ-Cognition

Score of the
test

Score of the
retest

27.31 5.84
10.33 2.71
7.53 2.27
9.44 2.75

26.82 5.71
10.11 2.79
7.47 2.08
9.24 2.30

Pearsons
correlation
coecient
.837
.830
.748
.798

P < 0.001.

performed to test the dierence of the TCI and NEO-PI


profiles for each Sasang-type group [13].
The data are presented as means and standard deviations
or frequency with percentage. All analyses were conducted
using PASW Statistics 18.0 for Windows (IBM, Armonk,

Rotation sums of squared loadings


Cumulative
Eigenvalue
percent of variance
percent
2.904
20.744
20.744
2.503
17.882
38.625
2.400
17.141
55.767

NY, USA) and P value of 0.01 and 0.001 were used for
significance.

3. Results
3.1. Analysis of SPQ and Its Subscales. Promax rotation
procedure with SPQ 14 items (Table 2) yielded three interpretable factors. Promax rotation ultimately confirmed three
interpretable subscales with cumulative explanatory value of
55.8% of the variance (Table 3).
The first factor, which accounted for 31.5% of the variance, included behavioral components of personality such
as do you consider yourself passive or proactive? Factor
2, which accounted for 14.9% of the variance, included
emotionality component of personality such as are you
relatively patient or impatient? Factor 3, which accounted
for 9.4% of the variance, included personality component

SPQ

0.827

0.301

0.649

0.387

0.364

0.265

0.314

0.462

NS

0.541

0.805

SPQ-C

0.452

0.137

0.513

0.390

HA

0.012

0.408

0.334

0.320

RD

0.167

0.099

0.403

0.225

TCI (n = 232)

0.153

0.226

0.358

0.148

SD

0.023

0.043

0.114

0.026

0.049

0.061

0.190

0.135

ST

0.329

0.339

0.320

0.168

0.452

0.288

0.683

0.629

0.129

0.094

0.192

0.182

0.263

0.036

0.081

0.171

NEO-PI (n = 97)

0.236

0.326

0.108

0.183

Co

P < 0.01; P < 0.001. Bold represents correlation coecient over 0.3.
SPQ: Sasang Personality Questionnaire, SPQ-B: SPQ-behavior, SPQ-E: SPQ-emotionality, SPQ-C: SPQ-cognition, TCI: temperament and character inventory, NS: novelty seeking, HA: harm avoidance, RD:
reward dependence, P: persistence, SD: self directness, C: cooperativeness, ST: self transcendence, NEO-PI: NEO-personality inventory, N: neuroticism, E: extraversion, O: openness to experience, A: agreeableness,
Co: conscientiousness.

SPQ-C

SPQ-E

SPQ-B

SPQ-E

SPQ-B

SPQ (n = 232)

Table 5: Correlation between SPQ, subscales of SPQ, TCI, and NEO-PI.

6
Evidence-Based Complementary and Alternative Medicine

Evidence-Based Complementary and Alternative Medicine


related to cognition/decision-making, such as do you have
a delicate or a tough personality?
The three factors were defined as follows. SPQ-behavior
(SPQ-B) measures the behavioral component of personality
(passive versus active); SPQ-emotionality (SPQ-E) measures
the emotionality component of personality (static versus
dynamic); finally, SPQ-cognition (SPQ-C) measures the
cognition/decision-making or cognitive component of personality (meticulous versus easy-going). The items comprising each subscale are outlined in Table 2. The Cronbachs
alpha of the three subscales from factor analysis was 0.789,
0.685, and 0.711, respectively. Furthermore, the SPQ showed
a significant correlation with SPQ-B (r = 0.827), SPQ-E (r =
0.649), and SPQ-C (r = 0.805). SPQ-B showed significant
correlation with SPQ-E (r = 0.301) and SPQ-C (r = 0.541).
The test-retest reliability of the SPQ and its subscales
were analyzed with Pearsons correlational analysis. Overall
test-retest reliability was found to be 0.837, and reliabilities of
the three subscales of SPQ-B, SPQ-E, and SPQ-C were 0.830,
0.748, and 0.798, respectively (Table 4).
The criterion validity of the SPQ was examined with the
TCI and NEO-PI. SPQ and its subscales showed significant
relations with the TCI and NEO-PI (Table 5).
3.2. SPQ and Sasang Typology. The biopsychological characteristics of the participants in this study were analyzed
to determine whether the SPQ demonstrates temperament
dierences between Sasang-type groups and to confirm
whether the TCI and NEO-PI scores replicate findings of
previous studies [9]. First of all, there were no significant
dierences between each Sasang type classified with the
QSCCII in gender (chi-square = 5,587; df = 2; P = 0.061)
and age (F = 0.831; df = 2,213; P = 0.437).
The SPQ subscales (SPQ-B, SPQ-E, and SPQ-C) of
each Sasang type showed significantly dierent profiles
(Figure 1(c)). The profile of the SPQ subfactors, namely,
SPQ-B, SPQ-E, and SPQ-C was not flat (Wilks Lambda test:
df = 2, F = 47.789, and P < 0.001). As for the parallelism
of SPQ subfactor profile with the interaction of Sasang type
were significantly dierent (Wilks Lambda test: df = 4, F =
4.920, and P = 0.001).
Significant dierences on the SPQ (F = 28.157; df =
2,213; P < 0.001), SPQ-B (F = 21.36; df = 2,213; P < 0.001),
SPQ-E (F = 9.019; df = 2,213; P < 0.001), and SPQ-C (F =
20.061; df = 2,213; P < 0.001) between Sasang types were
demonstrated with ANOVA. Post hoc analysis showed that
the SPQ of the So-Yang type (30.90 5.23) was significantly
higher than that of the Tae-Eum type (27.33 5.88) (P =
0.002), and that of the Tae-Eum type was significantly higher
than that of the So-Eum type (24.43 4.93) (P = 0.005),
while SPQ score of the So-Yang type was significantly higher
than that of the So-Eum type (P < 0.001). Post hoc analysis
showed that the SPQ-B of the So-Yang type (11.62 2.27)
was significantly higher than that of the Tae-Eum type
(9.91 2.93) and the So-Eum type (8.90 2.44) (P = 0.002;
P < 0.001), respectively. Post hoc analysis showed that the
SPQ-E of So-Yang type (8.67 2.51) is significantly higher
than those of Tae-Eum type (7.23 2.32) and So-Eum type

7
(7.23 1.97) (P = 0.003; P = 0.001), respectively. Post
hoc analysis showed that the SPQ-C of the So-Eum type
(8.302.45) is significantly lower than those of Tae-Eum type
(10.19 2.62) and So-Yang type (10.62 2.33) (P < 0.001;
P < 0.001), respectively.
The TCI temperament (novelty seeking, harm avoidance,
reward dependence, and persistence) of each Sasang type
exhibited significantly dierent profiles (Figure 1(a)). The
profile of the TCI temperament dimension was not flat
(Greenhouse-Geisser test: df = 2.542, F = 48.867, and P <
0.001). As for the parallelism of TCI temperament profile
with the interaction of Sasang types, they were significantly
dierent (Greenhouse-Geisser test: df = 5.083, F = 5.694, and
P < 0.001).
The significant dierences on the TCI novelty seeking (F
= 7.315, df = 2,222, and P < 0.001), TCI harm avoidance
(F = 7.985, df = 2,222, and P < 0.001), and TCI reward
dependence (F = 3.106, df = 2,222, and P = 0.047) between
Sasang types were demonstrated with ANOVA. Post hoc
analysis showed that the TCI harm avoidance of the So-Yang
type (34.92 10.06) and Tae-Eum type (35.88 12.76) was
significantly lower than that of the So-Eum type (41.57
11.86) (P = 0.002, and P = 0.012, resp.).
The NEO-PI subscales did not show significant profile
dierences between Sasang types (Figure 1(b)). However,
the significant dierences on the NEO-PI conscientiousness
(F = 5.648, df = 2,93, and P = 0.05) between Sasang
types were demonstrated with ANOVA. Post hoc analysis
showed that the NEO-PI conscientiousness of the So-Yang
type (48.39 7.49) was significantly lower than that of the
So-Eum type (54.58 7.63) (P = 0.006). The NEO-PI
extraversion of the So-Yang type (55.00 10.04) was higher
than that of So-Eum type (49.56 9.60), but not statistically
significant.

4. Discussion
Personalized medicine revolves around the use of safe and
eective medical treatment best fit to specific patients,
and this theme has been a major concern in both Western orthodox and traditional Eastern medicine. Sasang
typology founded in Neo-Confucianism is a temperamentbased personalized medicine using acupuncture and medical
herbs [10]. In order to provide a more objective and
empirical assessment of Sasang-type temperament profile
and contribute to broadening diagnostic index for Sasang
typology, we developed the Sasang Personality Questionnaire
(SPQ), which can measure the psychological traits of Sasang
typology, and validated the robust psychological structure of
the SPQ in this study.
Reliability and validity examination of the 14-item SPQ
demonstrated that the SPQ shows the benefit of multifaceted
structural analysis of Sasang typology across the domains of
behavior, emotionality, and cognition with acceptable reliability and stability [35]. Furthermore, the biopsychological
features of each Sasang type when compared with the TCI
and NEO-PI replicated previous clinical studies [9, 13, 36
38], and such results further illustrate the usefulness of the
SPQ in clinical use.

Evidence-Based Complementary and Alternative Medicine

12

60

11

55

10

50

45

40

35

30

6
SPQ-B

SPQ-E

NS

SPQ-C

HA

RD

SD

So-Yang (n = 63)
Tae-Eum (n = 60)
So-Eum (n = 102)

So-Yang (n = 60)
Tae-Eum (n = 57)
So-Eum (n = 99)
(a)

(b)

60

55
50
45
40
N

Co

So-Yang (n = 31)
Tae-Eum (n = 29)
So-Eum (n = 36)
(c)

Figure 1: SPQ subscale, TCI and NEO-PI dimension profile of each Sasang type. (a) SPQ subscale score of each Sasang type. The SPQ
subscale profile of the So-Yang, Tae-Eum, and So-Eum types was significantly dierent (flatness with Wilks Lambda test, df = 2, F = 47.789,
and P < 0.001; parallelism with Wilks Lambda test, df = 4, F = 4.920, and P = 0.001). The So-Eum type (8.90 2.44, 7.23 1.97, 8.30 2.45)
scored significantly (P < 0.001) lower on the SPQ-B, SPQ-E, and SPQ-C scales than So-Yang types (11.62 2.27, 8.67 2.5, 10.62 2.32),
respectively. (b) TCI score of each Sasang type. The profile of TCI temperament dimension, such as NS, HA, RD, and P was significantly
dierent (flatness with Greenhouse-Geisser test, df = 2.542, F = 48.867, and P < 0.001; parallelism with Greenhouse-Geisser test, df = 5.083,
F = 5.694, and P < 0.001). So-Eum type (32.03 9.28, 41.57 11.86) scored significantly lower on NA and higher on HA than So-Yang type
(37.92 9.59, and 34.92 10.06) (P = 0.001, and P < 0.002), respectively. (c) NEO-PI score of each Sasang type. The profile of NEO-PI was
not significantly dierent. So-Eum type (54.58 7.63) scored significantly higher on conscientiousness scale than So-Yang type (48.39 7.49)
(P = 0.006). P < 0.01; P < 0.001. Whisker represents standard errors. SPQ: Sasang Personality Questionnaire, SPQ-B: SPQ-behavior,
SPQ-E: SPQ-emotionality, SPQ-C: SPQ-cognition, TCI: temperament and character inventory, NS: novelty seeking, HA: harm avoidance,
RD: reward dependence, P: persistence, SD: self directness, C: cooperativeness, ST: self transcendence, NEO-PI: NEO-personality inventory,
N: neuroticism, E: extraversion, O: openness to experience, A: agreeableness, Co: conscientiousness.

It was found that the SPQ measures three facets of


personality associated with Sasang typology, namely, behavior, emotionality, and cognition. More specifically, the SoEum type scored relatively lower on the SPQ such that its
personality can be characterized as passive (behavior), static
(emotionality), and meticulous (cognition). In contrast, the
personality profile of the So-Yang type can be characterized
as active (behavior), dynamic (emotionality), and easy-going
(cognition) as indicated by a higher score on the SPQ. From
the perspective of traditional Korean medicine, such characteristics of the SPQ subscales reflect the basic theoretical

foundation of Eastern philosophy that the smaller change in


behavior, emotionality, and cognitive characteristics of the
SPQ mirror the Yin (So-Eum type), while greater change
mirrors the Yang (So-Yang type).
If we sum up these results, SPQ is a reliable and objective
psychological measurement of the So-Eum : Tae-Eum : SoYang axis as suggested in previous studies [14] and has theoretical connections with the Western psychological discipline
[9], which is useful for further comparative studies. The
lower extreme of the Sasang personality axis was again found
to be the So-Eum type, which exhibits low novelty seeking

Evidence-Based Complementary and Alternative Medicine


and high harm avoidance on the TCI, and low extraversion
on the NEO-PI, while at the other extreme lies the So-Yang
type which demonstrates opposite psychological features.
The Tae-Eum type is located in the middle and has a higher
body mass index compared to both the So-Yang and So-Eum
types.
The psychological structure of the SPQ subscales was
compared with existing validated psychological instruments
using correlational analysis. The results indicated that the
SPQ and its subscales are generally in the same direction as
the TCI. However, it was found that the SPQ-emotionality
subscale demonstrated a positive correlation with NEO-PI
neuroticism, but the SPQ-behavior and SPQ-cognition subscales showed negative correlations (Table 5). The NEO-PI
neuroticism is a sum of heterogeneous traits [39] and operationally defined as irritability, anger, sadness, impulsiveness,
vulnerability, hostility, and worry [4042]. Although features of SPQ-emotionality items including being impatient,
illogical, and greater emotional change appear related to
the construct of neuroticism, the SPQ-behavior and SPQcognition items representing proactiveness, fluency and
directness in expression of personal opinion, energetic
nature, and tough personality seem contradictory to the
traditional characteristics of neuroticism (Table 2).
This disparity could be the reason why current and
previous studies [38] failed to show significant dierences
in NEO-PI neuroticism between Sasang types, even though
neuroticism has been suggested as the major axis of Sasang
typology with indirect evidences from studies using the STAI,
BDI, and other assessment tools [9]. Further studies are
needed to determine medical implications of such dierences
between NEO-PI neuroticism and emotionality, behavior,
and cognition on the SPQ that was founded on Eastern
medicine.
As for the behavioral, emotional, and cognitive facets of
the Sasang personality in this study, the manner in which an
individual will evaluate a particular situation or environment
will be determined by the individuals emotional state,
which will in turn be expressed in various corresponding
behavioral forms judged to be suitable to the situation
or event. For example, the positive aect-negative aect
dimension has emerged as an important dimension of an
individuals emotional experience, such that self-estimate of
such aect results in expressions of mood that correspond
to measures of personality and emotionality, in addition
to making possible predictions of cognitive performance
[43]. The associations between extraversion and positive
aect and between neuroticism and negative aect are well
documented [44]. In one study, it was found that the
personality construct of extraversion and neuroticism contributed to negative and positive aects indirectly through
emotional reappraisal, suggesting that depending on the
type of personality dimension an individual holds, dierent
emotion regulation strategies or cognitive appraisal styles
might exist [45].
Since there are insucient studies examining the biopsychological basis and its medical value in dierent medical typologies, more scrupulous and practical studies are
needed. Current studies with conventional Western medicine

9
have reported that specific temperaments make a person predisposed to certain disease and aect its prognosis. For example, although much disagreement still exists, the link between
cancer and type C personality was suggested wherein a
personality that suppresses emotions and shows diculty in
coping with stress [46], and a possible association between
coronary heart disease and type D personality, where one
demonstrates negative aectivity and social inhibition [47,
48] have been proposed.
The SPQ and its subscales (SPQ-behavior, SPQemotionality, and SPQ-cognition) showed three facets of
Sasang personality and provide further rationale for how
ones personality may aect health in clinical health psychology studies [18, 49]. The personality trait of extraversion, for
instance, can be characterized by positive aect, approach
behavior, and broad focus, while the trait of neuroticism
can be marked by negative aect, inhibition of behavior, and
narrow focus. It will be important to examine the association
of such a tripartite model with disease vulnerability, progress,
and outcome across the Sasang types.
The relationship between stress and anxiety (neuroticism) has gained much interest in recent days. Predisposition
of the HPA axis related to the stress response, the functioning
of the stress-related response by the interleukin and natural
killer cell have also been proposed as potential mediators
in the stress-response cycle [50]. The hostility score on
the Minnesota Multiphasic Personality Inventory (MMPI),
negative aectivity of the Positive and Negative Aect
Scale (PANAS), neuroticism of the fives factor model, and
optimism determines the stress response which ultimately
aects health-related pathophysiology [51], and neuroticism
and extraversion have been reported to have influence on
morbidity and mortality [4, 18, 49]. For example, this can
be related to studies on stress response in that threatening
or frustrating stimuli may activate the fight-flight-freezing
system (FFFS), which produces active avoidance (anxiety and
flight) or attempted elimination (anger and attack). Even
stimuli or situations that contain potential threat can activate
the behavioral inhibition system (BIS), which may result in
vigilance, rumination, and passive avoidance as well as anxiety [52]. The constructs of agentic extraversion, characterized by assertiveness, dominance, and ambition, have been
distinguished from aliative extraversion, characterized by
sociability and aliative bonding [53] are similar in content
to the items of our SPQ-cognition subscale.
This study has several limitations that may aect generalizability. First, this study should be repeated with a larger
and more balanced sample size. Although the TCI and NEOPI scores of each Sasang-type groups in this study were not
significantly dierent compared to previous studies [13, 38],
the prevalence (So-Yang : Tae-Eum : So-Eum) of Sasang-type
groups in this study was 2 : 2 : 3, not the proposed 2 : 5 : 3
described in the previous studies, which may have resulted in
the possibility of selection bias from the dierence in Sasangtype group sample size ratio [7, 13]. There also should be
studies considering age and gender dierences [14] in Sasang
typology if the SPQ is to be used as a generalized measure of
the Sasang personality construct.

10
Second, SPQ-behavior, SPQ-emotionality, and SPQcognition were extracted as the subscales of SPQ, and these
should be validated with diverse psychological instruments
alongside with their stability. In particular, as the SPQemotionality correlated with NEO-PI neuroticism while,
SPQ, SPQ-behavior, and SPQ-cognition negatively correlated with NEO-PI neuroticism, other assessments much
are examined to see whether such patterns continue to
hold. The reason for distinct dierences in emotionality
or neuroticism dimension between Western psychology and
Sasang typology should be analyzed to determine if such
dierences result from cultural or philosophical disparities,
clinical experience, personality construct, or other factors
[54].
Third, the possibility of response bias, or the tendency
of participants to provide socially acceptable responses,
cannot be ruled out, especially as they must self-assess using
the SPQ. However, this may have been minimized due
to the forced-choice nature of the SPQ and the fact that
participants were unaware of its scoring method. In addition,
the relatively high test-retest reliability score of the SPQ and
the replication of theory-driven association with the NEO-PI
and TCI suggest that the likelihood of response bias may have
been reduced in the present study.
Last but not least, the clinical usefulness of SPQ should
be substantiated using clinical samples. Although the psychological and biometric profiles of each Sasang type in
this study using the QSCCII are a replication of previous
clinical studies [13, 38], there still lies a possibility of age,
gender, and socioeconomical characteristics that together
may aect Sasang-type classifying method. A future study
testing whether the SPQ can predict individuals response to
acupuncture and medical herbs with various age groups in
clinical situations should be conducted.
In conclusion, the Sasang Personality Questionnaire
which can objectively measure the psychological personality
basis of Sasang typology was developed and validated
with Western psychometric instruments in this study. With
further clinical investigation, the SPQ may serve as a solid
foundation for personalized medicine with medical herbs
and acupuncture by providing a biopsychosocial typology
perspective.

Conflict of Interests
The authors declare that they have no conflict of interests.

Funding
Korea Science and Engineering Foundation (KOSEF) grant
funded by the Korean government (MEST) (Grant no.
20110027739).

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Submit your manuscripts at


http://www.hindawi.com
BioMed
Research International

PPAR Research
Hindawi Publishing Corporation
http://www.hindawi.com

Hindawi Publishing Corporation


http://www.hindawi.com

Volume 2014

Volume 2014

Journal of

Obesity

Journal of

Ophthalmology
Hindawi Publishing Corporation
http://www.hindawi.com

Volume 2014

Evidence-Based
Complementary and
Alternative Medicine

Stem Cells
International
Hindawi Publishing Corporation
http://www.hindawi.com

Volume 2014

Hindawi Publishing Corporation


http://www.hindawi.com

Volume 2014

Journal of

Oncology
Hindawi Publishing Corporation
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Volume 2014

Hindawi Publishing Corporation


http://www.hindawi.com

Volume 2014

Parkinsons
Disease

Computational and
Mathematical Methods
in Medicine
Hindawi Publishing Corporation
http://www.hindawi.com

Volume 2014

AIDS

Behavioural
Neurology
Hindawi Publishing Corporation
http://www.hindawi.com

Research and Treatment


Volume 2014

Hindawi Publishing Corporation


http://www.hindawi.com

Volume 2014

Hindawi Publishing Corporation


http://www.hindawi.com

Volume 2014

Oxidative Medicine and


Cellular Longevity
Hindawi Publishing Corporation
http://www.hindawi.com

Volume 2014